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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In aged people a differentiation has to be made between "arteriosklerotic hypertension" due to increased stiffness of the aorta and true hypertension in older patients. The therapy of hypertension in older patients principally is the same as in younger individuals; however, blood pressure should be lowered slowly with the respect to concomitant diseases of the kidney, coronary arteriosclerosis and heart failure. Usually, in older patients there long-standing hypertension with increased peripheral resistance and low cardiac output. Therefore, a diuretic or vasodilating agent may be the drug of first choice. Betablockers are not generally contraindicated, but given with caution. The same is true for ganglionblocking agents. In a large number of cases salt restriction and general measures will lead to a suitable blood pressure control.
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PMID:[Modern treatment of hypertension in older patients (author's transl)]. 610 2

By means of a case-control study, social and biomedical factors were considered in relation to transient cerebral ischemic attack occurrence as determined by questionnaire and interview among a population of females ( greater than 50 years of age) residing in the city of utrecht and surroundings. Contrary to earlier expectations, a greater TIA risk was found associated with: lower systolic and diastolic blood pressure, a low-salt diet for high blood pressure, lower body weight, smaller body surface, and use of medicines for cardiac insufficiency/arrhythmias and chronic anxiety. The importance of hemodynamic processes (i.e. hypotensive episodes of cerebral circulation) for TIA within the general population is emphasized.
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PMID:Unexpected trends in the analysis of a questionnaire and interview procedure to detect transient cerebral ischemic attack in a female population. 627 71

VIP containing nerves are present in the kidney and plasma VIP levels are elevated in cardiac failure and severe liver disease. We studied the effects of intravenous VIP; 6 pmol kg-1 min-1 on 6 normal subjects and 3 patients with liver disease. In normal subjects VIP produced flushing and significant rises in heart rate and pulse pressure but the clearance rates of paraaminohippurate and creatinine did not change significantly. Urine flow fell to about 1/3 and the rate of excretion of electrolytes (except phosphate) fell to about a half of control values. Plasma renin activity rose about 3-fold and there were significant rises in haematocrit and the plasma concentrations of solids, calcium and phosphate. The patients with liver disease responded similarly. Elevated plasma VIP could contribute to salt and water retention in disease states.
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PMID:Renal function during vasoactive intestinal peptide (VIP) infusions in normal man and patients with liver disease. 638 98

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given. Seventy-seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi-liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis. The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.
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PMID:Evaluation of clinical and biological parameters in marastic Kwashiorkor children treated by parenteral nutrition. 640 30

A series of 123 healthy pregnant women (average age: 28 years) was studied by M mode and 2D echocardiography to evaluate the hemodynamic changes due to pregnancy. Latent and asymptomatic pericardial effusion was detected in 19 of the 46 patients in the last stages of pregnancy (32nd to 38th week). The effusion was slight in 13 cases, moderate in 4 cases and voluminous in 2 cases. This was a transient finding, occurring at the end of pregnancy (never before the 32nd week) and regressing totally in the two months post partum. The pregnancy ran its natural course in all 19 patients. None had any specific past medical history or clinical signs of toxemia. Cardiovascular examination was normal in all cases with no signs of pericardial friction rub or of heart failure. However, the blood pressure was raised in 3 of the 19 patients. The ECG was normal in 16 of the 19 cases; non-specific ST-T wave changes were observed in 3 cases. Pericardial effusion was probably related to salt and water retention which often occurs at the end of pregnancy: at this stage the average weight gain was significantly higher (p less than 0,03) in the 19 patients with pericardial effusion than in the 27 patients without (13,6 +/- 4,3 kg compared to 10,9 +/- 3,7 kg). Therefore, pericardial effusion of variable volume but always asymptomatic and latent was observed in 40,1 p. 100 of patients at the end of pregnancy on echocardiographic examination. This previously undocumented finding requires further study to determine the underlying physiopathological mechanism and its exact significance.
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PMID:[Echocardiographic detection of asymptomatic pericardial effusion during normal pregnancy]. 640 17

A double blind trial was carried out comparing 15 g sodium amidotrizoate and 15.3 methyl glucamine amidotrizoate for urography. The sodium preparation resulted in significantly better visualisation of the urinary tract, both in normal patients and in those with renal insufficiency. For routine urography in the given dose there was no difference as regards demonstration of the parenchyma and filling of the urinary tract. Similarly, there was no difference in tolerance after the intravenous administration of the two substances. The sodium salt should be avoided in patients with cardiac failure, whereas these are better tolerated than methyl glucamine salts by asthmatics. Judging by our results, the sodium salts are to be preferred for routine urography in a dose of 50 ml., particularly for patients with mild to moderate renal insufficiency.
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PMID:[Sodium or methyl glucamine salts as contrast media for urography (author's transl)]. 645 36

One hundred fourteen patients with ruptured cerebral aneurysms were reviewed in regard to the incidence and etiological factors of preoperative disturbances of water and electrolyte metabolism. Patients with inadequate salt intake, evidence of renal disease, cardiac failure or excessive diuretic therapy were excluded. Twenty-five (21.9%) patients developed water and electrolyte disturbances. Hyponatremia (less than 130 mEq/l) occurred in 18 (15.8%) of 114 patients. The majority of those patients with hyponatremia showed laboratory findings and/or clinical features suggesting the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The mean interval between the last subarachnoid hemorrhage (SAH) and the development of hyponatremia was 13.5 days (range 6 to 26 days). No patients developed hypernatremia (more than 155 mEq/l). Preoperative diabetes insipidus (DI) occurred in 7 (6.1%) of 114 patients. The mean interval between the last SAH and the onset of DI was 26.5 days (range 15 to 35 days). When compared with the onset of hyponatremia following SAH, the development of DI was significantly delayed. The present study showed that the following five types of patients significantly related to the development of preoperative water and electrolyte disturbances after SAH due to cerebral aneurysms. The patients with ruptured aneurysms of anterior communicating, anterior cerebral artery or internal carotid artery. The patients in grade III, IV according to Hunt & Hess. The patients with high density in the basal subarachnoid space on the CT scan. The patients with a small hematoma in the region of the basal frontal interhemispheric fissure in cases with aneurysms of the anterior communicating or anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Etiology of water and electrolyte metabolism imbalance following the rupture of cerebral aneurysms--with special reference to preoperative condition]. 646 63

In most normal subjects, the fractional excretion of sodium is usually less than 1 percent but may be raised with an increase in salt intake. In acutely azotemic patients, a low fractional excretion of sodium usually indicates a prerenal process that is responsive to volume repletion. However, such a low fractional excretion of sodium also can be seen with azotemia due to hepatic or cardiac failure, as well as acute glomerulonephritis, pigment nephropathy, contrast nephrotoxicity, polyuric renal failure associated with burns, acute obstruction, renal transplant rejection, and occasionally non-oliguric acute renal failure, none of which is a volume-responsive process. A fractional excretion greater than 1 percent in acutely azotemic patients usually indicates intrinsic renal injury, but is consistent with volume depletion in patients receiving diuretics or in some patients with chronic renal insufficiency. Similarly, a low quotient in acute renal parenchymal injury is usually interpreted to indicate widespread tubular integrity, but is consistent with several different pathophysiologic processes. The fractional excretion of sodium must be interpreted in light of the specific clinical setting and other laboratory data to be useful in patient management.
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PMID:Interpreting the fractional excretion of sodium. 648 45

The therapeutic activity of digitalis in cardiac failure is linked to its positive inotropic effect on the myocardium and its ability to control cardiac activity in atrial fibrillation. Chronic stimulation with digoxin in aged subjects with sinus rhythm, however, is of debatable utility Reference is made to a series of 35 subjects (mean age 76.5 yr) in sinus rhythm, 30 of whom had been taking digoxin for over 3 yr. Clinical and instrumental parameters were assessed and heart function was classified according to the NYHA arrangement. Subjects were randomly placed in two groups matched for sex, age and cardiac condition. The first group received digoxin, the second a placebo. No significant differences between the two groups were noted over a 3-month period. In keeping with the recent literature, it is felt that digitalis is not necessary for the dynamic cardiac control of aged subjects in sinus rhythm. In addition, it is suggested that hydrosaline retention in such subjects can be controlled by restriction of salt intake, rest and diuretics.
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PMID:[Use of digitalis in geriatrics: is it effective on the heart in sinus rhythm?]. 683 63

Renin Activity (PRA), Aldosterone (PA), Sodium (PNa) and Potassium (PK) in plasma and Aldosterone (UA), Sodium (UNa) and Potassium (UK) in 24 hrs urine were measured in 11 cases of heart failure compensated with treatment (HFCT) consisting in digoxin 0.25 mg daily, furosemide 40 to 80 mg daily, potassium chloride 1.5 g daily and low salt diet and in 12 cases of refractory heart failure (RHF). Mean and standard deviation of PRA, PA, PNa, PK, UA, UNa and UK were 9.7 +/- 8.2 mg/cc/hr. 24.2 +/- 14.0 mg/100 cc, 142.2 +/- 4.7 mEq/1, 4.9 +/- 0.3 mEq/1, 8.7 +/- 9.1 ug/24 hrs, 89.3 +/- 50.0 mEq/24 hrs and 50.0 +/- 26.7 mEq/24 hrs, respectively for cases with HFCT and 61.7 +/- 37.5, 120.3 +/- 125.8, 133.1 +/- 4.3, 4.9 +/- 0.4, 21.3 +/- 19.2, 9.9 +/- 19 and 33.3 +/- 12.0 respectively for subjects with RHF. The statistical analysis of PRA, PA, PNa and UNa, revealed differences between the two groups with p values of less than or equal to 0.05, less than or equal to 0.001, less than or equal to 0.001, less than or equal to 0.001, respectively. The other values were statistically non significant. These data suggest the existence of an stimulatory state of the renin-angiotensin-aldosterone system (RAAS) in the RHF and a normal state in HFCT. The lack of electrolytic changes suggestive of aldosteronism in RHF may be due to an alteration of aldosterone receptors or to hemodynamic renal factors. In heart failure hemodynamic changes rather than humoral factor seems to control RAAS.
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PMID:[The renin-angiotensin-aldosterone system in compensated and uncompensated cardiac insufficiency]. 701 36


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